SI Joint Fusion :: The Question of Angle

When I was considering which type of minimally invasive sacroiliac joint fusion I was most comfortable with, one of my major concerns was the angle at which the implants were placed. Many of the more common types of fixation are lateral, meaning the implants are inserted across the joint. I met with two surgeons who subscribed to that approach, and I was pretty convinced that going across the joint was the best placement option, in terms of creating long term stability.


So when I first met with Dr. Carter Beck I asked him about that, because his approach is not only posterior, he places the implants at a different angle. I told him I was concerned that his procedure would result in a weaker stability (oxymoron, I know) and he explained why he believed it was the exact opposite.


Now I KNOW my illustration here isn’t an exact representation of how the implants are placed, but in an attempt to shed light on my understanding of the difference between a lateral and posterior approach, I’ve drawn lines on the image below. The black line represents the lateral approach. It goes directly across the joint and is inserted from the side of the buttock. The blue line represents the posterior approach. It is inserted from the back of the pelvis, and is more diagonal in nature.


Dr. Beck’s answer to my question convinced me that I wanted to go with the posterior approach. When I tried to explain the mechanics of it to others, I did a terrible job. So when I was at his office yesterday for my post-op visit, he kindly let me take a video of his explanation. My purpose in posting this video is NOT to make a professional medical case for one approach over the other. If you read my blog, you know by now that I am not qualified to do that. I’m simply reporting what I learned about what Dr. Beck believes, and why I made the decision I did. Keep in mind: I do NOT think he’s saying that all lateral approaches are doomed to failure. Nor do I think he’s saying that all posterior surgeries will be resounding successes. He’s talking about his own theory and why he chooses that approach. Beyond that, it’s up to you to decide.